Health information technology (health IT) can help improve health care quality, prevent medical errors, and reduce health care costs by delivering essential information at the time and place of care.  There are two crucial components of effective health IT – widespread use of electronic health records by providers and the ability to exchange health information privately and securely.

While both are challenging projects conceptually, technologically, and economically, the development of secure information exchange poses special challenges.  Trusted health information exchange requires the involvement of a broad range of stakeholders – patients, providers, payors, purchasers, and health agencies – and the consideration of a broad range of policies, principles and designs.

To address these challenges, the Maryland Health Care Commission (MHCC) and the Health Services Cost Review Commission (HSCRC) proposed a two-phase strategic plan involving several parallel planning projects followed by a single implementation project.  Primary objectives of this strategic plan for private and secure health information exchange include:

1. Building a statewide clinical data sharing utility for data exchange in Maryland
2. Identifying private and public policies regarding privacy, confidentiality, and access
3. Implementing projects connecting disparate health IT systems
4. Determining an appropriate financial and business model for sustainability of a Maryland Regional Health Information Organization
5. Ensuring that Maryland’s clinical data sharing application and data exchange process is consistent with national standards
6. Identifying legislation necessary to support the voluntary exchange of clinical data
7. Encouraging business, health care, and policy leaders to create agendas and funding for clinical data exchange
8. Facilitating creation of common governance, process, technology, and other elements needed for implementing a statewide clinical data sharing utility

Planning Projects

The HSCRC funded up to three planning projects through hospital rate adjustments of up to $250,000 each.  The Request for Application (RFA) was developed by MHCC, and was shaped by extensive stakeholder input through informal and formal comment periods that were open to all interested parties.

Each applicant for the planning project was a multi-stakeholder group that included at least one Maryland hospital.  From November 2007 through July 2008, each project developed a strategy for phased implementation of a statewide health information exchange (HIE).  The plan included proposed solutions to a specific series of issues:  governance, privacy and security, role-based access, user authentication and trust hierarchies, architecture of the exchange, hardware and software solutions, costs of implementation, alternative sustainable business models, and strategies to assure appropriate patient engagement, access, and control over information exchange.

Planning Team Reports

Chesapeake Regional Information System for our Patients (CRISP)

Montgomery County Health Information Exchange Collaborative (MCHIE)

Implementation Project

The challenge at the implementation phase was bringing together the results of the Maryland planning and pilot projects with information from exchange projects nationwide to craft an RFA for an implementation project in Maryland.  The RFA was drafted following extensive consultation and open comment from Maryland organizations.  The HSCRC anticipated making as much as $10 million available through rate adjustments to hospitals.

Although structured as a competitive application for an implementation project, great weight was given to:

• A demonstrated ability to bring multiple stakeholders together to resolve policy issues and to craft creative solutions to technical and operational challenges
• The functionality, scalability, and cost-effectiveness of the proposed project for the private and secure exchange of clinical information
• The capacity of the exchange to serve additional public purposes, including public health, post-marketing drug surveillance, and health services research
• The ability to engage consumers and develop trust in the privacy and security of the system
• The long term financial viability of the exchange

Request for Application for A Consumer-Centric Health Information Exchange for Maryland

Addendums:

Responder Notification - May 8, 2009

Responder Notification - June 3, 2009

HIE RFA Questions and Answers: A Consumer-Centric Health Information Exchange in Maryland - May 5, 2009 

Recommendation for a Statewide HIE: Commissioner Presentation Materials

HIE Recommendation Brief

HIE Recommendation Presentation

CRISP Response to RFA

HIE Flyer